Competencies Needed for Behavioral Health Professionals to Integrate Digital Health Technologies into Clinical Care: a Rapid Review.

This rapid review examines literature on training and competencies for behavioral health professionals to integrate digital health technologies into clinical practice. While the evidence for digital health is growing, research evidence supports its use in behavioral healthcare. Despite this, behavioral health professionals have been slow to integrate technologies into care for various reasons. The aim of this review is to inform behavioral health professionals on competencies needed to support the adoption of digital health technologies. PubMed and Google Scholar were searched for articles from 2010 through 2020. Search terms associated with digital health technologies, behavioral health professionals, and competencies, skills, training, and best practices yielded 1972 articles. Twenty-three articles met inclusion criteria indicating foundational core competencies and data was extracted and organized based on profession and technology platform in order to detect similarities and differences. The findings were used to generate an interdisciplinary approach for the clinical integration of digital health. Recommendations are presented for foundational digital health competencies applicable across behavioral health disciplines, rather than technology- or discipline-specific training. The universal digital health inter-professional competencies identified include: (a) privacy, security, and patient safety; (b) digital health technical skills; (c) ethical and legal considerations; (d) clinical skills; (e) art of therapy and digital health; and (f) administrative tasks. Research is needed to understand if the development of professional digital health competencies helps to improve patients' behavioral health.

Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy.

BACKGROUND/OBJECTIVE: Urine drug testing (UDT) may be used to help screen for prescription opioid misuse. There are little data available describing usual pain care practices for patients who have aberrant UDT results. The goal of this research was to evaluate the clinical care for patients prescribed chronic opioid therapy (COT) and have an aberrant UDT. DESIGN: Retrospective cohort study. SETTING: VA Medical Center in the Pacific Northwest. PARTICIPANTS: Patients with chronic pain who were prescribed COT and had a UDT result that was positive for an illicit or nonprescribed substance. MAIN OUTCOME MEASURES: This was an exploratory study designed to document usual care practices. RESULTS: Participants' (n = 83) mean age was 49.5 (SD = 9.6) and 81.5 percent were male. The most common substances detected on UDT were marijuana (69 percent) or a nonprescribed opioid (25 percent); 18 percent had a UDT positive for two or more substances. Plans to modify treatment were documented in 69 percent of cases. The most common treatment change after aberrant UDT results was instituting more frequent UDTs, which occurred in 43 percent of cases. Clinicians documented plans to alter their opioid prescribing (eg, terminating opioids, requiring more frequent fills, changing opioid dose, or transitioning to another opioid) in 52 percent of cases, but implemented these changes in only 24 percent. DISCUSSION: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.

Care management practices for chronic pain in veterans prescribed high doses of opioid medications.

BACKGROUND: There is growing interest in the primary care management of patients with chronic non-cancer pain (CNCP) who are prescribed long-term opioid therapy. OBJECTIVE: The aim of this study was to examine the care management practices and medical utilization of patients prescribed high doses of opioids relative to patients prescribed traditional doses of opioids. METHODS: We conducted a retrospective cohort study of veterans who had CNCP in 2008 and reviewed medical care for the prior 2 years. Patients with CNCP who were prescribed high-dose opioid therapy (≥180mg morphine equivalent per day for 90+ consecutive days; n = 60) were compared with patients prescribed traditional dose opioid therapy (5-179mg morphine equivalent per day for 90+ consecutive days; n = 60). RESULTS: Patients in the high-dose group had several aspects of documented care that differed from patients in the traditional dose group, including more medical visits, attempting an opioid taper, receiving a urine drug screen and developing a pain goal. The majority of variables that were assessed did not differ between groups, including documented assessments of functional status or co-morbid psychopathology, opioid rotation, discussion of treatment side effects, non-pharmacological treatments or collaboration with mental health or pain specialists. CONCLUSIONS: Further work is needed to identify mechanisms for optimizing care management for patients with CNCP who are prescribed high doses of opioid medications.

Chronic pain treatment and health service utilization of veterans with hepatitis C virus infection.

OBJECTIVES: Hepatitis C virus (HCV) infection is estimated to affect 2% of the general U.S. population and chronic pain is a common comorbidity among persons with HCV. The primary purpose of this study was to compare health service utilization of U.S. military veterans with HCV with and without the presence of comorbid chronic pain. DESIGN: Cross-sectional study with retrospective review of patient medical records. PATIENTS: One hundred seventy-one U.S. military veterans with confirmed HCV, recruited through a single U.S. Veterans Administration hospital. OUTCOME MEASURES: Medical service utilization data from the past 5 years were extracted from participants' electronic medical records. RESULTS: Sixty-four percent of veterans with HCV (N = 110) had chronic pain. Veterans with HCV and chronic pain utilized more health services including total inpatient stays (odds ratio [OR] = 2.58 [1.46, 4.56]) and days hospitalized for psychiatric services (OR = 5.50 [3.37, 8.99]), compared to participants with HCV and no chronic pain, after statistically adjusting for demographic, psychiatric, substance use, medical comorbidity, and disability covariates. In addition, those with HCV and chronic pain had more total outpatient visits with primary care providers (OR = 1.73 [1.15, 2.59]), physical therapists (OR = 9.57 [4.79, 19.11]), and occupational therapists (OR = 2.72 [1.00, 7.48]). CONCLUSIONS: Patients with HCV and chronic pain utilize medical services to a greater extent than patients with HCV but no chronic pain. Future studies that examine the efficacy of both pharmacological and nonpharmacological pain treatment for patients with comorbid HCV and chronic pain appear warranted.